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Pelvic Anatomy, Cephalopelvic Disproportion, Intrapartum Sonography and Neuraxial Analgesia

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Intrapartum Ultrasonography for Labor Management

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Abstract

The pelvis is not only a functional bone but has great importance in obstetrics. Because of bipedal locomotion, the shape and size of the pelvis became more straight. In this situation the only way to delivery large brained fetus is that the fetal head has to perform complex rotation and turning movements (cardinal movements) during the progress in the birth canal. The problem may arise from cephalopelvic disproportion (CPD) that is present when the fetal head is too large to pass through the pelvis. CPD and related obstructed labor is responsible for 2–8% of maternal mortality worldwide and furthermore can cause poor progress of labor and can be indication for operative vaginal delivery (OVD) or primary cesarean section (CS).

Labor pain is the most severe pain that women can experience during their lives, and neuraxial labor analgesia (NLA) is a most effective and widely used analgesic modality in labor for obtaining pain relief.

Intrapartum ultrasonography (IU) can represent an important diagnostic tool during physiologic labor and delivery, as like in dystocic or obstructed labor. With this technique, obstetrician can improve the diagnosis of fetal head position, progression, and internal rotation in comparison to vaginal digital examination (VDE). The use of IU during neuraxial analgesia can aid in the diagnosis of fetal head malposition and malrotation, alert obstetrician onto the possibility of dystocic labor, indicate the need to discontinue drug administration in NLA, and shift to OVD or CS. The reduction of dystocia misdiagnosis by using IU has modified CS and OVD rates. The administration of drugs doses in NLA without a diagnosis of malpresentation in dystocic labor may prolonged labor and increases the likelihood of dystocia.

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Authors and Affiliations

  1. Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, Policlinico Riuniti Foggia, University of Foggia, Foggia, Italy

    Renata Beck & Gilda Cinnella

  2. Department of Obstetrics and Gynecology, Santa Maria Hospital, GVM Care & Research, Bari, Italy

    Antonio Malvasi

  3. International Translational Medicine and Biomodelling Research Group, Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow, Russia

    Antonio Malvasi

  4. Laboratory of Human Physiology, Faculty of Biological and Medical Physics, Phystech BioMed School, Moscow Institute of Physics and Technology (State University), Moscow, Russia

    Antonio Malvasi

  5. Santa Maria della Misericordia University Hospital, University of Perugia, Perugia, Italy

    Antonio Malvasi

  6. Department of Anesthesiology, UZ Leuven, Leuven, Belgium

    Mark Van De Velde

  7. Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium

    Mark Van De Velde

Authors
  1. Renata Beck
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  2. Antonio Malvasi
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  3. Gilda Cinnella
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  4. Mark Van De Velde
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Editors and Affiliations

  1. Department of Obstetric and Gynecology, Santa Maria Hospital, GVM Care and Research, Bari, Italy

    Antonio Malvasi

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Beck, R., Malvasi, A., Cinnella, G., Van De Velde, M. (2021). Pelvic Anatomy, Cephalopelvic Disproportion, Intrapartum Sonography and Neuraxial Analgesia. In: Malvasi, A. (eds) Intrapartum Ultrasonography for Labor Management. Springer, Cham. https://doi.org/10.1007/978-3-030-57595-3_46

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  • DOI: https://doi.org/10.1007/978-3-030-57595-3_46

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